tbuckley/cabot-search huggingface dataset:
POS0635 DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS: EXPERIENCE IN A RHEUMATOLOGY OUTPATIENT PRIVATE CENTRE
Authors: C. Villota-Eraso, J. C. Sarmiento-Monroy, D. C. Varela, M. J. Mantilla Ribero
Journal: Annals of the Rheumatic Diseases (2022)

Background Patients with difficult-to-treat rheumatoid arthritis (D2T RA) have not achieved treatment target despite treatment according to EULAR recommendations. Information on the incidence rates of D2T RA in a real-life setting is lacking. Objectives To estimate the prevalence of D2T RA in a well-characterized cohort. Methods This was a cross-sectional analytical study of patients with RA (1987 ACR criteria). Each patient was evaluated and followed by a rheumatologist from January 2014 to December 2021 in a single rheumatology outpatient private center in Bogotá, Colombia. RA patients were classified as D2T RA according to EULAR definition. Results A total of 783 patients were evaluated. Baseline characteristics were as follows: female gender 91.1%, mean age 54.4±13 years, mean disease duration 13.9±9.3 months, RF positive 92.4%, ACPA positive 59.5%, and erosions 44.3%. 32.9% have extra-articular manifestations and 31.6% at least one comorbidity. Most of patients have received conventional synthetic DMARDs (97.8%), being prednisone and methotrexate the most frequently prescribed. Seventy-nine (10%) patients were classified as D2T RA. The current treatments were conventional synthetic DMARD alone 18.9%, combination with bDMARD 79.4%, and 78.5 with glucocorticoids. Main characteristics of the patients are shown in Table 1. Table 1. D2T RA (n=79 ) Demographics Age, years 54.4 Female, % 91.1 Comorbidity 31.6 Smoking 37.9 Disease characteristics Disease duration, months 13.9 RF positivity, % 92.4 ACPA positivity, % 59.5 PAI 10.1 EAM 32.9 Drugs Number of previous bDMARDs, mean 2.89 Glucocorticoid therapy, mean dose per day (mg) 18.4 RF: rheumatoid factor; ACPA:anti-citrulinated protein antibodies; PAI: poliautoimmunity, EAM: extra-articular manifestations, bDMARD: disease-modifying biologic antirheumatic drug; D2T: difficult-to-treat; n: number; mg miligrams Conclusion D2T AR is common and represents a phenotype with a significant burden of comorbidities and a high prevalence of poor prognostic factors. This concept should be recognized and taken into account to bring a personalized approach. References [1]Nagy G, Roodenrijs NMT, Welsing PMJ, et al. Ann Rheum Dis 2021;80:31–35. [2]Takanashi S, et al. Characteristics of patients with difficult-to-treat rheumatoid arthritis in clinical practice. Rheumatology (Oxford). 2021;60(11):5247-5256 [3]Roodenrijs NMT, et al. Difficult-to-treat rheumatoid arthritis: contributing factors and burden of disease. Rheumatology (Oxford). 2021;60(8):3778-3788. Disclosure of Interests None declared
POS1300 PAIN AND ITS ASSOCIATION WITH HEALTH-RELATED QUALITY OF LIFE, SLEEP, PHYSICAL ACTIVITY, AND SEDENTARY BEHAVIOR IN 10-YEAR-OLD CHILDREN FROM A SWEDISH BIRTH COHORT
Authors: J. S. Malmborg, J. Roswall, G. Almquist-Tangen, J. Dahlgren, B. Alm, S. Bergman
Journal: Annals of the Rheumatic Diseases (2022)

Background Pain in children may be underreported and undertreated today, but due to methodological variations, pain prevalence is difficult to determine. Moreover, it is unclear to what extent pediatric pain is associated with health-related quality of life (HRQoL) and other lifestyle habits. There is a need for an increased understanding of pain in children. Objectives To study pain prevalence and cross-sectional associations between pain, HRQoL, sleep, physical activity, and sedentary behavior in 10-year-old children from a Swedish birth cohort. Methods The Swedish birth cohort the “Halland Health and Growth Study” (H 2 GS) recruited 2860 children at birth (2007–2009). At 10 years of age the children answered questionnaires regarding pain (mannequin with 20 regions, frequency never–daily for each region) and HRQoL (Kidscreen-27, 27 questions, 5 domains scored worst–best). Parents estimated their child’s sleep (6–8, 9, or 10–12 hours/night), physical activity time, and sedentary time (hours/weekdays and hours/weekends respectively). Children were categorized into the groups of “infrequent pain” (never–monthly pain) or “frequent pain” (weekly–almost daily pain) from the highest reported pain frequency from at least one body region. Differences in pain prevalence between boys and girls were analyzed with chi 2 -test. Logistic regression analyses were performed to study associations between frequent pain (dependent variable) and HRQoL, sleep, physical activity, and sedentary behavior (independent variables). Each variable was adjusted for sex. Results 733 children (351 boys and 382 girls) answered pain and HRQoL questions at 10 years of age. Frequent pain was reported by 37% (boys 35% vs. girls 39%, p=0.267). The number of frequent pain regions ranged from 1–13 in boys and 1–20 in girls. Higher HRQoL in the domains physical wellbeing (OR 0.965; 95%CI 0.948–0.983; p&lt;0.001), psychological wellbeing (OR 0.971; 95%CI 0.955–0.987; p&lt;0.001), autonomy and parents (OR 0.971; 95%CI 0.954–0.988; p=0.001), peers and social support (OR 0.977; 95%CI 0.961–0.994; p=0.007), and school environment (OR 0.972; 95%CI 0.956–0.989; p=0.002) was associated with less risk of belonging to the frequent pain group. More sedentary time in weekdays (OR 1.107; 95%CI 1.028–1.192; p=0.007) and weekends (OR 1.122; 95%CI 1.037–1.215; p=0.004) was associated with having frequent pain, but no associations were found between frequent pain and the amount of physical activity or sleep. Conclusion The high prevalence of frequent pain in 10-year-old children must receive attention by the school and health-care services. The association between frequent pain and low HRQoL is troublesome. Improving HRQoL and reducing sedentary time is beneficial for children’s health, but further studies are needed to follow associations over time. Disclosure of Interests None declared
AB1575-PARE DIETS AND JOINT SYMPTOMS: SURVEY OF MOROCCAN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATISM
Authors: N. Takhrifa, T. Fatima Zahrae, I. Berrichi, A. Anass, K. Berrada, F. Abourazzak
Journal: Annals of the Rheumatic Diseases (2022)

Background The role of diet in triggering or aggravating chronic diseases, in particular chronic inflammatory rheumatism (CIR), is a question frequently asked by patients. Objectives The objective of our study is to investigate whether Moroccan patients report a relationship between certain diets or foods and the symptoms of the disease and also to study whether patients adopt specific eating behaviors in order to relieve their symptoms. Methods This is a survey based on a questionnaire that included any patient followed for CIR who presents to the rheumatology department. The questionnaire has 3 parts: 1) Sociodemographic data, comorbidities, and information on the CIR (type, duration of evolution, activity, functional impact and treatments), 2) beliefs and attitudes of patients in this regarding diet in relation to their CIRs 3) a list of 24 foods for which patients are asked whether they worsen, improve or leave their joint symptoms unchanged. Results To date we have included 120 patients. The average age was 45.3 ± 13.4, 73.3% of the patients were women, 39.3% had comorbidities, 50% were illiterate, 57.5% were followed for RA and 42.5% for SPA. The median duration of evolution of the RIC was 7 years [3; 15], for the treatments 45% of the patients in our study were on corticosteroid therapy, 3.3% used a biological treatement while 7.5% received no treatment. 25% of patients think that the diet influences the activity and/or the evolution of the rheumatism. 26% of subjects said food had an effect on their CIR, with 11.7% reporting improvement and 25% worsening. Honey (6.7%), garlic (5%) and olive oil (4.2%) were the foods most often cited as improving CIR symptoms, while red meat (18.3%), fish (6.7%) and legumes (3.3%) were most often cited as aggravating symptoms. 20.8% of patients declare that they have avoidance behaviors vis-à-vis certain foods while 7.5% adopt certain diets and 3.3% have already tried fasting in order to relieve joint symptoms. In uni and multivariate analysis no factor, only the duration of evolution was associated with the fact of declaring that food has an influence on the symptoms of the CIR (OR: 0.947, IC95%: [0.901-0.996], p=0.03). Conclusion The results of our investigation suggest a possible link between certain foods and joint pain in patients followed for CIR. References [1]Sara K. Tedeschi et al, Diet and Rheumatoid Arthritis Symptoms: Survey Results From a Rheumatoid Arthritis Registry, 2017 Arthritis Care &amp; Research Disclosure of Interests None declared
The Concept of Transient Ischemic Attack—Reply
Authors: J. Donald Easton, S. Claiborne Johnston
Journal: JAMA (2022)

In Reply In response to our recent Viewpoint on replacing the term TIA,1 Dr Kirshner states, “The authors proposed the term acute ischemic cerebrovascular syndrome in its place, stating that all focal ischemia in the brain can cause tissue damage.” We stated:
AB0187 UNTREATED EARLY RHEUMATOID ARTHRITIS WITH ONSET IN THE YOUNGER (18-49 YEARS) AND OLDER (50 YEARS AND OLDER) AGE ACCORDING TO PRACTICAL HEALTH CARE. COMPARATIVE STUDY
Authors: A. Satybaldyev, G. Gridneva, A. Misiyuk, K. Kasumova, N. Demidova, N. Chichasova, E. Nasonov
Journal: Annals of the Rheumatic Diseases (2022)

Background Comparative characteristics of various clinical manifestations in untreated early rheumatoid arthritis (RA) in younger and older age patients is not sufficiently covered in the literature. Objectives To compare the frequency of different clinical manifestations in younger (18-49 years) and older (50 years and older) age patients with early RA who had not received background therapy yet. Methods 292 patients (men-65, women - 227, mean age 53.57±16.08 years) with early-stage RA were selected from 5327 patients included in the All-Russian register of patients with arthritis OREL from 01/01/2012 to 31/12-2018. They were studied during the first visit before prescription of background therapy (DMARDs: synthetic, biologics or other targeted drugs and systemic glucocorticoid therapy). 141/227 patients had RA onset at 18-49 years age (group 1): men-25, women-116, mean age (m±SD) 39.27±7.97 years. 151/227 patients had RA onset at 50 years or older age (group 2): men -41, women -110, mean age 66.05±7.34 years. RA was diagnosed according to ACR 1987 and ACR/EULAR 2010 criteria. Disease activity was assessed according to DAS-28 index, radiological stage – Steinbrocker classification, functional disorders - according to functional class (FC). Results The male/female ratio in group 1 was 1:4.6, in group 2 - 1:2.8 (p=0.055). Following disorders developed more often in group 2 than in group 1: morning stiffness (82% vs. 59%) (p&lt; 0.05), lesions of small joints of the hands (76% vs. 65%) (p &gt;0.05), wrist joints (65% vs. 52%) (p&lt; 0.05), elbow (33% vs. 17%) (p&lt; 0.05), knee (53% vs. 36%) (p&lt; 0.05), shoulder (44% vs 19%) (p&lt; 0.05), the total number of affected symmetrical pairs of joints (452 vs 285) (p&lt; 0.001). Patients of group 2 showed more pronounced inflammatory process than in group 1: high activity - 66% vs. 35%, respectively (p&lt; 0.05), as well as destructive changes in joints (erosive arthritis - 52% vs. 29%; p&lt; 0.05) and functional disorders (FC 3 - 68% vs. 15%, respectively). RF was detected with equal frequency in both groups (72% vs 72%, respectively; p&gt;0.05), and ACPA was more frequently positive in group 1 (89 vs 78%, respectively; p&lt;0.037). Conclusion Comparative study of the clinical characteristics of the natural course of early RA with onset in younger age (18-49 years) and with onset in older age (50 years and older) according to the data of the All-Russian register of patients with arthritis OREL showed that RA with onset in older age is characterized by stronger inflammatory process, destructive and functional disorders in the joints than RA with onset at a younger age. Disclosure of Interests None declared
AB0449 THE PREVALENCE OF AUTOANTIBODIES AGAINST IFNΑ IS HIGH IN SLE AND ASSOCIATED WITH A HIGH FREQUENCY OF TUBERCULOSIS
Authors: M. Beydon, P. Nicaise Roland, A. Mageau, T. Goulenok, C. Farkh, P. Dieudé, E. Daugas, V. Descamps, J. F. Timsit, T. Papo, K. Sacre
Journal: Annals of the Rheumatic Diseases (2022)

Background IFNα and anti-IFNα autoantibodies have been implicated in susceptibility both for systemic lupus erythematosus (SLE) and viral infection. Objectives We aimed to analyze the SLE disease phenotype and risk for infection associated with anti-IFN-α IgG autoantibodies in SLE patients Methods In this multidisciplinary retrospective single referral center study, all consecutive patients with SLE admitted between January 1 st and November 30 th 2020 were considered. All subjects fulfilled the ACR/EULAR 2019 criteria for SLE. Anti-IFNα IgG autoantibodies were quantified at admission by ELISA. Demographic, medical history, laboratory, treatment, and outcome data were extracted from electronic medical records using a standardized data collection form. Results 180 patients [female 87.2%, median age of 44.4 (34-54.2) years] were included. The median disease duration was 10 years [4-20] with a median SLEDAI score of 2 [0-4] at study time. Fifty-four (30%) patients had a past-history of lupus nephritis. One hundred and forty-four (80%) had received long-term glucocorticoids and 99 (55%) immunosuppressive drugs. Overall, 127 infections - mostly bacterial and viral - were reported in 95 (52.8%) patients. Twenty SLE patients (11.1%) had positive anti-IFNα IgG autoantibodies with a titer ranging from 10 to 103 UA/mL. Age, sex, SLE phenotype and treatment did not significantly differ between SLE patients with or without anti-IFNα. Infection rate was similar in both groups except for tuberculosis which was more frequent in patients with anti-IFNα (20% vs 3.1%, p = 0.01). Conclusion The prevalence of autoantibodies against IFNα is high in SLE and associated with a higher frequency of tuberculosis Disclosure of Interests None declared
AB0412 CYCLING OF JAK-INHIBITORS IN PATIENTS WITH RHEUMATOID ARTHRITIS: A SINGLE-CENTRE EXPERIENCE
Authors: C. Vassallo, L. Sammut
Journal: Annals of the Rheumatic Diseases (2022)

Background Despite the availability of multiple effective disease-modifying antirheumatic drugs (DMARDs), discontinuation/switching of treatment is common for many patients with rheumatoid arthritis (RA). Janus kinase (JAK) inhibitors or JAKi, are the latest class of DMARDs approved for RA. Data on the outcomes of cycling JAKi in RA patients is still limited to this day. Objectives To assess the outcomes of switching between JAKi baricitinib, tofacitinib and upadacitinib in a real-world cohort of RA patients. Methods This was a hospital-based, retrospective observational study of all RA patients treated in a single-centre. Data was collected between 2016 and 2021 for all patients who failed JAKi and were treated with another JAKi. Demographic data, antibody status, history of DMARD use and clinical outcomes were assessed according to change in disease activity scores, time to JAKi discontinuation and reason for switching based on DAS 28-CRP scores. Results We identified 26 RA patients, 23 (88%) of which were RhF and/or anti-CCP positive, that failed JAKi and were cycled to another JAKi. 23 (88%) patients had failed treatment with one or more biological therapies prior to initiating JAKi. 13 (50%) patients were prescribed baricitinib and the other 13 patients Tofacitinib as their initial JAKi. During their RA treatment pathway, 9 (35%) of the patients on tofacitinib switched to baricitinib, and 4 (15%) switched to upadacitinib. 7 (27%) patients who started on baricitinib were switched to upadacitinib, and 6 (23%) were switched to tofacitinib. 3 (12%) patients cycled between all 3 JAKi. Reasons for switching first JAKi included primary treatment failure at initial 3-month rescore due to lack of efficacy (7/26; 27%), secondary failure (9/26; 35%), adverse drug reactions (ADR) (2/26; 8%) and others (1/26; 4%). Additionally, 7 (27%) patients on tofacitinib were switched following a drug safety update published by the Medicines and Healthcare products Regulatory Agency (MHRA), in an effort to minimize risk of major adverse cardiovascular events and malignancies. The median time to switching first JAKi was 11.5 months (range 3-23 months). After switching JAKi, 17 (65%) patients were found to have improved DAS 28-CRPs at their 3-month rescore and continued treatment with their second JAKi. Following their switch, a total of 8 (31%) patients stopped their second JAKi due to inefficacy, 3 (12%) due to ADRs and 2 (8%) for other reasons. Of the 3 patients that went on to receive treatment with a 3 rd JAKi (2/3 for primary failure; 1/3 for secondary failure), 2 patients were found to improve at their 3-month rescore. Conclusion Cycling through JAKi is an appropriate and safe treatment strategy in RA patients that discontinue first JAKi therapy due to lack of efficacy or ADR. References NA Disclosure of Interests None declared
AB0167 FUNCTIONAL DISABILITIES IN HANDS PRECEDE THOSE IN FEET IN PATIENTS PROGRESSING FROM CLINICALLY SUSPECT ARTHRALGIA TO RHEUMATOID ARTHRITIS; A LONGITUDINAL OBSERVATIONAL STUDY
Authors: S. Khidir, B. van Dijk, E. van Mulligen, A. van der Helm-van Mil
Journal: Annals of the Rheumatic Diseases (2022)

Background In the pre-arthritis phase of Rheumatoid Arthritis (RA), symptoms resulting in physical disabilities already occur. It is unknown whether functional disabilities start in hands or feet, and whether such information on functional disabilities is related to arthritis development. Objectives To study the course of functional disabilities in hands and feet during progression from arthralgia to RA, and whether questions assessing specifically these disabilities contribute to predicting progression to RA. Methods 600 patients with clinically suspect arthralgia were studied for development of clinical inflammatory arthritis (IA) (median follow-up 25 months). Functioning was measured with the Health Assessment Questionnaire Disability-Index (HAQ) at baseline and after 4,12,24 months. HAQ-items assessing hands-functioning (dressing/eating/grip) and feet-functioning (walking) were studied. In patients who developed IA, the longitudinal course of functional disabilities towards IA-development was studied, using linear mixed models with date of IA-development as timepoint zero. ACPA-stratification was applied. Associations between HAQ-questions at presentation and future IA-development were studied with cox-regression analysis, including age, sex, CRP, ACPA and RF. Results 99 patients developed IA. In these patients, feet-functioning at presentation with arthralgia was less impaired than hands-functioning. Disabilities involving hands and feet both rose significantly towards IA-development (hands 0.25units/year, 95%CI=0.04-0.45, p&lt;0.019; feet 0.29units/year, 95%CI=0.08-0.50, p=0.008, on HAQ-scale of 0-3; see Figure). However, hands-disabilities were reported earlier and were more severe than feet-disabilities during the total course (overall difference=0.41units; 95%CI=0.28-0.55, p&lt;0.001). This was similar in both ACPA-subtypes. In the total arthralgia-population, a single question on difficulties with dressing (a HAQ-question involving hands-functioning) was as predictive as total HAQ≥1 for IA-development. This was independent of regularly used predictors; HR 2.3 (95%CI=1.5-3.6, p&lt;0.001). Conclusion Functional disabilities in hands precede those in feet during RA-development. A single question on dressing difficulties adds value to risk stratification in patients with clinically suspect arthralgia and is easy to use in practice. Disclosure of Interests None declared
AB1576-PARE RHEUMATOID ARTHRITIS ASSESSMENT KNOWLEDGE QUESTIONNAIRE (RAKE) IN TUNISIAN POPULATION
Authors: S. Rekik, Z. Zeineb, S. Jemmali, S. Boussaid, S. Rahmouni, K. Zouaoui, H. Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2022)

Background Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that has a very high burden on patients their families, and society. So that it is important that RA patients receive education about their disease. The knowledge of RA patients in Tunisia regarding their disease has not yet been assessed. Objectives The purpose of the study was to evaluate disease-specific knowledge of patients with rheumatoid arthritis by using the RAKE questionnaire (Rheumatoid Arthritis assessment Knowledge Questionnaire). Methods This was a cross-sectional study. Adults with RA fulfilling the ACR/EULAR criteria were asked to participate by responding to RAKE Questionnaire in the short version. Results A total of 28 RA patients were included: 23 females (82%) 5 mens (18%). The mean age was 58.5 years with a range of 31 to 79 years. The mean disease duration was 9.8 years. The disease duration was 0-5 years in 5 (17.8%) patients, and more than 5 years in 23 (82.2%) cases. Twenty patients were housewives. Thirteen (46.4%) patients were from rural areas. Almost all of the patients didn’t follow education programs for their RA. Twenty-two (78.5%) patients obtained information’s RA from their rheumatologist. Six patients (21.5%) from other sources (neighbors, nurses, other RA patients, social media). The mean time for answering the questionnaire was11.6 min (9-15 min).The RAKE total score was11.8/32 [3-22]. For the initial part of the questionnaire, related to the general aspects of RA, the mean score was 4.3/8 [0-6]. The mean score of the second component of the questionnaire concerning medications and non-pharmacological management, was respectively 4.3/11 [0-7] and 2.3/5 [0-4]. For comorbidities, the mean score was 0.6/1. The fourth component includes auto-management, pain, and tiredness the mean score was1.4/3 [0-3]. The last component covers psychosocial, occupational, and health system coping skills. Its mean score was 2.1/4. The mean score of unknown answers was 6.7/32 [4-16]. Conclusion In our study, the knowledge patients of RA was low in all domains of RAKE questionnaire at various degrees. These findings can be used for improving current patient education programs and better disease control. Disclosure of Interests None declared